This week's question is answered by John Burns CPC, senior consultant for DecisionHealth Professional Services.

Q.   Are there guidelines as to how far apart EKGs must be to bill for them? For example, can EKGs less than two or three minutes apart be billed and paid?

The Center for Disease and Control (CDC) tells providers treating patients suspected to have the H1N1 influenza virus to obtain a respiratory swab sample and call their state or local health department for testing. CMS says Medicare will pay for diagnostic flu tests, such as a nasal swab.

Now that the swine flu has been in the news for weeks, practices are learning what works and what doesn't - and how to react calmly and consistently in the face of a pandemic. The outbreak of swine flu, or H1N1 influenza virus, has been the main news story since the World Health Organization announced the world was on the brink of a pandemic April 22. Providers, medical societies and consultants have since reported increases in patient calls and visits. 

This chart compares denial rates for diagnostic, screening and therapeutic colonoscopies from 2005 to 2007. Denial rates are based on the total number of denied services divided by the total number of claims filed for each code.

You'll have 144 new ICD-9 diagnosis codes to use starting Oct. 1, according to a proposed federal rule. CMS has also released 170 E codes for external causes of injury that will also effective at the start of the 2010 fiscal year in October.

CMS has started to receive potential new audit targets from Recovery Audit Contractors, says Connie Leonard, RAC project officer in CMS's Office of Financial Management. Only two issues submitted so far relate to physicians and CMS hasn't approved either, she says. Approved targets will be made public at the end of May or in early June, she says.

The Federal Trade Commission (FTC) granted providers a last-minute reprieve from enforcing the Red Flag Rules. On April 30, the evening before the Red Flag Rules was due to go into effect, the FTC announced that it will put a three month hold on the rule. The new deadline is Aug. 1.

It's still too early to know which services and billing patterns Recovery Audit Contractors (RACs) will target when the permanent program begins this summer, but the rollout will be methodical and move hand-in-hand with outreach efforts, a top official with one RAC tells Part B News. 

Sen. Max Baucus (D-Mont.) is determined to have a finished health reform bill by the end of this summer. Speaking to a crowd of reporters in Washington on April 24, Baucus repeated two of his convictions: that pay-for-performance will be a crucial ingredient and that "nothing's off the table," to help maximize the chance of passing a bill with actual Republican support.

CMS has put the brakes on a much-ballyhooed program to encourage medical practices to purchase electronic health records after the recently passed economic stimulus law rendered the effort redundant. At last month's annual meeting of the Healthcare Information and Management Systems Society (HIMSS) in Chicago, the Medicare agency said it was canceling Phase II of its national EHR demonstration in wake of the passage of the American Recovery and Reinvestment Act. The move affects approximately 800 practices in eight communities.